1
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Ramanadhan S, Jensen J. The Levonorgestrel-Releasing Intrauterine Device as Emergency Contraception: Re-examining the Data. Obstet Gynecol 2024; 143:189-194. [PMID: 37989139 DOI: 10.1097/aog.0000000000005466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023]
Abstract
Emergency contraception methods that also deliver ongoing contraception provide the most effective options for individuals hoping to prevent pregnancy after unprotected intercourse. Although the copper intrauterine device (IUD) provides the most effective option for emergency contraception because the device prevents pregnancy when placed before implantation and offers long-acting contraception, uptake by patients has been limited. Recently, the Society of Family Planning issued new guidance recommending the levonorgestrel IUD (LNG-IUD) as an emergency contraception option along with the copper IUD. Here, we review evidence related to this recommendation and conclude that the available data do not support use of the LNG-IUD for emergency contraception. We discuss the mechanisms of action of emergency contraception methods and how these concepts interface with the current political and social landscape of contraception and abortion care. We describe limitations of the existing evidence supporting use of the LNG-IUD as emergency contraception and highlight the critical research needed to establish the device as a highly effective method of emergency contraception.
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Affiliation(s)
- Shaalini Ramanadhan
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
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2
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Hernández-Silva G, Vega CC, Barrera D, Hernández-Pando R, García-Uribe PÁ, Chirinos M, Larrea F. Gene Expression Changes in the Ovary Mediate Non-Anovulatory Mechanisms of Contraception with Levonorgestrel. Arch Med Res 2023; 54:102892. [PMID: 37804815 DOI: 10.1016/j.arcmed.2023.102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Emergency contraception with levonorgestrel (LNG) is a viable option to prevent unintended pregnancies. Although the efficacy of LNG as an anovulatory agent decreases as treatment approaches ovulation, it still provides some contraceptive benefits. AIM To better understand the contraceptive mechanisms of LNG in ovulatory subjects. METHODS We conducted a study on Wistar rats that received a single dose of LNG (0.01 or 0.05 mg/kg) on the morning of proestrus before ovulation and evaluated its effects on ovarian gene expression, ovulation, and implantation. RESULTS Our findings showed changes in the expression of genes involved in follicular development and oocyte quality. Pregnancy rates - as an indicator of ovulation - and embryo implantation were significantly lower than those in the control group. CONCLUSIONS This study suggests that LNG alters regulatory factors in the ovary that are essential for the development of competent fertilizable oocytes, highlighting the non-anovulatory mechanisms by which levonorgestrel may regulate fertility and suggesting that it could be a novel observation that contributes to the understanding of emergency contraception in humans.
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Affiliation(s)
- Gabriela Hernández-Silva
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Claudia Cecilia Vega
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Barrera
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Experimental Pathology Lab, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pablo Ángel García-Uribe
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mayel Chirinos
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Fernando Larrea
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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3
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Telbiyska K, Angelova M. Ectopic Pregnancy Following Levonorgestrel Emergency Contraception: Report of Two Cases. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Abstract
Ectopic pregnancy (EP) is likely to occur as an unwanted complication after unprotected intercourse in spite of levonorgestrel emergency contraception (LNG-EC). Its incidence has been increasing recently.
We present 2 cases of tubal EP after the oral use of levonorgestrel, treated by laparoscopy.The first unruptured EP with unclear ultrasound findings, because of uterine ventrofixation after the caesarean section (CS) . The second case is a ruptured EP after LNG –EC on day 24 of the period with mild haemoperitoneum with severe peritoneal irritation.
The fundamental question is whether levonorgestrel participates in the etiology of EP.
The etiology of EP involves many factors. Levonorgestrel mechanisms of action give us grounds to believe theoretically that it increases the risk of EP and participates as an etiological factor.
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4
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Sawyer L. β-Lactoglobulin and Glycodelin: Two Sides of the Same Coin? Front Physiol 2021; 12:678080. [PMID: 34093238 PMCID: PMC8173191 DOI: 10.3389/fphys.2021.678080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 12/22/2022] Open
Abstract
The two lipocalins, β-lactoglobulin (βLg) and glycodelin (Gd), are possibly the most closely related members of the large and widely distributed lipocalin family, yet their functions appear to be substantially different. Indeed, the function of β-lactoglobulin, a major component of ruminant milk, is still unclear although neonatal nutrition is clearly important. On the other hand, glycodelin has several specific functions in reproduction conferred through distinct, tissue specific glycosylation of the polypeptide backbone. It is also associated with some cancer outcomes. The glycodelin gene, PAEP, reflecting one of its names, progestagen-associated endometrial protein, is expressed in many though not all primates, but the name has now also been adopted for the β-lactoglobulin gene (HGNC, www.genenames.org). After a general overview of the two proteins in the context of the lipocalin family, this review considers the properties of each in the light of their physiological functional significance, supplementing earlier reviews to include studies from the past decade. While the biological function of glycodelin is reasonably well defined, that of β-lactoglobulin remains elusive.
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Affiliation(s)
- Lindsay Sawyer
- School of Biological Sciences, IQB3, The University of Edinburgh, Edinburgh, United Kingdom
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5
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Maxwell C, McKendrick J, Hanlon C, Penson P, Fleming V. Exploring pharmacists' views surrounding conscientious objection to abortion and implications in practice. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:258-264. [PMID: 33876827 DOI: 10.1093/ijpp/riab009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/06/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND General Pharmaceutical Council standards (UK) state 'pharmacy professionals have the right to practise in line with their religion, personal values or beliefs as long as they …make sure that person-centred care is not compromised', indicating a potential conflict for pharmacists who wish to exercise their right to conscientious objection (CO) to abortion while maintaining a duty of care to their patients. OBJECTIVE The objective of this study was to explore pharmacists' views of conscientious objection to abortion and whether this included the supply of EC and the impact on practice. METHOD Eighteen UK pharmacists were interviewed using semistructured interviews. Interviews were transcribed verbatim, imported into NVivo11 and analysed using thematic analysis. KEY FINDINGS Five themes were identified: beliefs as to what constitutes abortion, influences on beliefs, conflicts of conscience, accommodating conscience and professional obligations. Views were polarised in relation to the role of emergency contraception (EC) as an abortifacient. Religion was often viewed as the reason underpinning CO to abortion. Conflicts in relation to CO to abortion included the role of referral and EC and employability for objectors. Some pharmacists viewed their role of providing patient choice as incompatible with the right of CO to abortion. CONCLUSIONS This study shows the conflicts and challenges surrounding CO to abortion in professional pharmacy practice. While the majority of pharmacists believe CO to abortion should and could be accommodated, this can prove challenging in certain working environments, both in relation to ensuring a duty of care to patients is upheld and due to the ongoing debate concerning EC and whether it has a definitive role in abortion or not.
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Affiliation(s)
- Clare Maxwell
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Jane McKendrick
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Claire Hanlon
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Peter Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Valerie Fleming
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
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6
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Sakurai S. Pregnancy rate after emergency contraception with single-dose oral levonorgestrel in Japanese women. J Obstet Gynaecol Res 2019; 45:1892-1898. [PMID: 31286635 PMCID: PMC6771957 DOI: 10.1111/jog.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Abstract
Aim To evaluate the pregnancy rate in Japanese women treated with levonorgestrel for emergency contraception. Methods This retrospective record‐based medical study included 1000 women who visited our clinic for emergency contraceptive treatment with 1.5 mg single‐dose oral levonorgestrel, followed by 50 μg hormonal oral contraceptive from May 2011 to December 2017. The outcomes of the emergency contraceptive treatment were recorded at a follow‐up visit, and descriptive statistics were obtained. Results The number of women treated with levonorgestrel at the clinic increased from 2011 to 2015, but there was no subsequent increase thereafter. Most women were in their 20s (57.4%), followed by their 30s (19.3%) and teens (18.3%). Of the 1000 women treated with levonorgestrel, 659 were followed up. Among the 659 women with follow‐up data, 16 were pregnant (2.4%), of whom 11 underwent abortions, three had miscarriages, and two delivered at term. The timing of unprotected sexual intercourse relative to the estimated ovulation date among the pregnant women ranged from −3 to 23 days. The most commonly used contraceptive method before the emergency contraceptive visit was condoms (89.3%, 887/993). No new safety concerns were identified throughout the study period. Conclusion The pregnancy rate after levonorgestrel treatment in Japanese women was low, and similar to that reported in previous studies. Information on contraceptive methods and emergency contraception with levonorgestrel needs to be better disseminated among women of childbearing age.
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7
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Narváez JF, Grant H, Gil VC, Porras J, Bueno Sanchez JC, Ocampo Duque LF, Sossa RR, Quintana-Castillo JC. Assessment of endocrine disruptor effects of levonorgestrel and its photoproducts: Environmental implications of released fractions after their photocatalytic removal. JOURNAL OF HAZARDOUS MATERIALS 2019; 371:273-279. [PMID: 30856437 DOI: 10.1016/j.jhazmat.2019.02.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
The presence of levonorgestrel (LNG) in water bodies via direct discharge and human excretion has been reported worldwide, but its effects on the reproduction of aquatic species and humans are still unknown. Owing to its recalcitrant properties, LNG is not completely removed during wastewater treatment plants, and many species may be exposed to low traces of this compound from discharged effluents. Thus, in this study, a photocatalytic process for removing LNG along with screening of endocrine disruptor effects for risk assessment was applied. Although the removal rate of LNG by ultraviolet C (UV-C) radiation was >90%, reproductive toxicity testing using the BeWo cell line exposed to LNG and its degraded fraction showed the reduced production of basal human chorionic gonadotropin hormone (β-hCG) by more than 73%, from 8.90 mIU mL-1 to <2.39 mIU mL-1, with both LNG and the degraded fraction. β-hCG hormone has been implicated in the viability of trophoblastic cells during the first trimester of pregnancy; therefore, degraded fractions and waterborne LNG may affect reproduction in some aquatic species and humans with low level of exposure.
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Affiliation(s)
- Jhon Fredy Narváez
- Grupo de Investigación Ingeniar, Facultad de Ciencias Básicas e Ingeniería, Corporación Universitaria Remington, Calle 51 No. 51-27, Medellín, Colombia.
| | | | - Vanessa Correa Gil
- Grupo de Investigación Ingeniar, Facultad de Ciencias Básicas e Ingeniería, Corporación Universitaria Remington, Calle 51 No. 51-27, Medellín, Colombia
| | - Jazmín Porras
- Grupo de Investigaciones Biomédicas UniRemington, Corporación Universitaria Remington, Calle 51 No. 51-27, Medellín, Colombia
| | - Julio Cesar Bueno Sanchez
- Grupo de Reproducción, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 # 52-21, Medellín, Colombia
| | | | - Ramiro Ríos Sossa
- Grupo de Investigación INFETTARE, Universidad Cooperativa de Colombia, Cra. 42 #49-137, Medellín, Colombia
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8
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Mozzanega B, Nardelli GB. UPA and LNG in emergency contraception: the information by EMA and the scientific evidences indicate a prevalent anti-implantation effect. EUR J CONTRACEP REPR 2019; 24:4-10. [DOI: 10.1080/13625187.2018.1555662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Bruno Mozzanega
- Department SDB Woman’s and Child’s Health, University of Padua, Padova, Italy
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9
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Haeger KO, Lamme J, Cleland K. State of emergency contraception in the U.S., 2018. Contracept Reprod Med 2018; 3:20. [PMID: 30202545 PMCID: PMC6123910 DOI: 10.1186/s40834-018-0067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.
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Affiliation(s)
- Kristin O. Haeger
- Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Women’s Health Services, 810 Vermont Ave., NW, Washington, DC, 20420 USA
| | - Jacqueline Lamme
- Department of Obstetrics & Gynecology, U.S. Naval Hospital Okinawa, Okinawa, Japan
| | - Kelly Cleland
- Office of Population Research, Princeton University, 218 Wallace Hall, Princeton, NJ 08544 USA
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10
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Del Río JP, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P. Steroid Hormones and Their Action in Women's Brains: The Importance of Hormonal Balance. Front Public Health 2018; 6:141. [PMID: 29876339 PMCID: PMC5974145 DOI: 10.3389/fpubh.2018.00141] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/27/2018] [Indexed: 12/19/2022] Open
Abstract
Sex hormones significantly impact women's lives. Throughout the different stages of life, from menarche to menopause and all stages in between, women experience dramatic fluctuations in the levels of progesterone and estradiol, among other hormones. These fluctuations affect the body as a whole, including the central nervous system (CNS). In the CNS, sex hormones act via steroid receptors. They also have an effect on different neurotransmitters such as GABA, serotonin, dopamine, and glutamate. Additionally, studies show that sex hormones and their metabolites influence brain areas that regulate mood, behavior, and cognitive abilities. This review emphasizes the benefits a proper hormonal balance during the different stages of life has in the CNS. To achieve this goal, it is essential that hormone levels are evaluated considering a woman's age and ovulatory status, so that a correct diagnosis and treatment can be made. Knowledge of steroid hormone activity in the brain will give women and health providers an important tool for improving their health and well-being.
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Affiliation(s)
| | | | | | | | | | - Pilar Vigil
- Reproductive Health Research InstituteSantiago, Chile
- Vicerrectoría de ComunicacionesPontificia Universidad Católica de Chile, Santiago, Chile
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11
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Chirinos M, Durand M, González-González ME, Hernández-Silva G, Maldonado-Rosas I, López P, Larrea F. Uterine flushings from women treated with levonorgestrel affect sperm functionality in vitro. Reproduction 2017; 154:607-614. [DOI: 10.1530/rep-17-0313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 12/28/2022]
Abstract
Levonorgestrel (LNG), a synthetic 19 nor-testosterone derivative, is widely used for emergency contraception. It is well known that LNG prevents ovulation only when given prior to the surge of serum luteinizing hormone (LH) during the periovulatory phase of the menstrual cycle. This observation suggests that LNG, given its contraceptive efficacy, has additional effects other than those affecting ovulation. In this study, we have evaluated the effects on human sperm functionality of uterine flushings (UF) obtained from women at day LH + 1 of a control cycle (CTR-LH + 1) and after receiving LNG (LNG-LH + 1) two days before the surge of LH. Human sperm from normozoospermic donors were incubated with UF and protein tyrosine phosphorylation, sperm motility, acrosome reaction as well as zona pellucida (ZP) binding capacity were assessed. A significant decrease in total motility and tyrosine phosphorylation accompanied by an increase on spontaneous acrosome reaction was observed when sperm were incubated in the presence of LNG-LH + 1. None of these effects were mimicked by purified glycodelin A (GdA). Moreover, the addition of UF obtained during the periovulatory phase from LNG-treated women or the presence of purified GdA significantly decreased sperm-ZP binding. The data were compatible with changes affecting sperm capacitation, motility and interaction with the ZP. These results may offer evidence on additional mechanisms of action of LNG as an emergency contraceptive.
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12
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Affiliation(s)
- R Alta Charo
- From the University of Wisconsin Law School, Madison
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13
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Lira-Albarrán S, Durand M, Larrea-Schiavon MF, González L, Barrera D, Vega C, Gamboa-Domínguez A, Rangel C, Larrea F. Ulipristal acetate administration at mid-cycle changes gene expression profiling of endometrial biopsies taken during the receptive period of the human menstrual cycle. Mol Cell Endocrinol 2017; 447:1-11. [PMID: 28219738 DOI: 10.1016/j.mce.2017.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
The aim of this study was to analyze the effects of mid-cycle administration of Ulipristal acetate (UPA) on gene expression in endometrial biopsies taken during the receptive phase of the cycle. Fourteen healthy menstruating women were studied during 14 control non-treated and 12 treated cycles with a single dose of 30 mg UPA when follicle diameter reached 20 mm. Ovulation in both treated and control cycles was confirmed by serial determinations of serum LH, progesterone and vaginal ultrasound. An endometrial biopsy at day LH+7, in each cycle, was taken for RNA microarray and qPCR analysis or prepared for histological and immunohistochemistry studies. Functional analysis of differentially expressed genes showed the presence of changes compatible with a non-receptive endometrial phenotype, further confirmed by qPCR and immunohistochemistry. This study suggests the effects of UPA on endometrial receptivity, offering a plausible explanation for the higher contraceptive efficacy of this method compared to that of levonorgestrel.
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Affiliation(s)
- Saúl Lira-Albarrán
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - Marta Durand
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - Marco F Larrea-Schiavon
- Departamento de Genómica Computacional, Instituto Nacional de Medicina Genómica, Periférico Sur No. 4809, Ciudad de México 14610, México
| | - Leticia González
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - David Barrera
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - Claudia Vega
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - Armando Gamboa-Domínguez
- Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México
| | - Claudia Rangel
- Departamento de Genómica Computacional, Instituto Nacional de Medicina Genómica, Periférico Sur No. 4809, Ciudad de México 14610, México
| | - Fernando Larrea
- Departamento de Biología de la Reproducción Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México.
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14
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Abstract
Unplanned or unintended pregnancy remains a significant challenge for adolescents; many teens who plan ahead but opt not to choose long-acting reversible contraceptive methods have high failure rates with condom usage, oral contraceptives, and other less long-acting methods. Emergency contraception (EC) remains a necessity for those adolescents seeking a second chance to prevent the unintended consequences of unplanned sexual activity. At present, 5 postcoital methods remain available as EC globally: intrauterine devices, ulipristal acetate, a selective progesterone modulator, mifepristone; levonorgestrel, and ethinyl estradiol plus levonorgestrel or norgestrel (rarely used now that progestin only methods are more readily available).
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Affiliation(s)
- Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, A120, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
| | - Veronica Issac
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, A120, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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15
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Lira-Albarrán S, Larrea-Schiavon MF, González L, Durand M, Rangel C, Larrea F. The effects of levonorgestrel on FSH-stimulated primary rat granulosa cell cultures through gene expression profiling are associated to hormone and folliculogenesis processes. Mol Cell Endocrinol 2017; 439:337-345. [PMID: 27663078 DOI: 10.1016/j.mce.2016.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Abstract
Levonorgestrel (LNG), a synthetic progestin, is used in emergency contraception (EC). The mechanism is preventing or delaying ovulation at the level of the hypothalamic pituitary unit; however, little knowledge exists on LNG effects at the ovary. The aim of this study was to identify the effects of LNG on FSH-induced 17β-estradiol (E2) production, including LNG-mediated changes on global gene expression in rat granulosa cells (GC). Isolated GC from female Wistar rats were incubated in vitro in the presence or absence of human FSH and progestins. At the end of incubations, culture media and cells were collected for E2 and mRNA quantitation. The results showed the ability of LNG to inhibit both hFSH-induced E2 production and aromatase gene expression. Microarray analysis revealed that LNG treatment affects GC functionality particularly that related to folliculogenesis and steroid metabolism. These results may offer additional evidence for the mechanisms of action of LNG as EC.
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Affiliation(s)
- Saúl Lira-Albarrán
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México.
| | - Marco F Larrea-Schiavon
- Department of Computational Genomics, Instituto Nacional de Medicina Genómica, Periférico Sur No. 4809, Ciudad de México 14610, México.
| | - Leticia González
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México.
| | - Marta Durand
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México.
| | - Claudia Rangel
- Department of Computational Genomics, Instituto Nacional de Medicina Genómica, Periférico Sur No. 4809, Ciudad de México 14610, México.
| | - Fernando Larrea
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Ciudad de México 14080, México.
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16
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Moral Certitude in the Use of Levonorgestrel for the Treatment of Sexual Assault Survivors. PHILOSOPHY AND MEDICINE 2017. [DOI: 10.1007/978-3-319-55766-3_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Abstract
Pharmacists’ ability to exercise “professional right of conscience” in dispensing emergency contraception, as well as the professionalism of pharmacists, has fallen under attack recently by the media, by state governments, and even by other healthcare professionals in published commentaries. This editorial discusses the controversy surrounding emergency contraceptives, the right of pharmacists to refuse to fill prescriptions that they consider morally objectionable, and the responsibility of pharmacists to provide medications in a timely and professional manner. The professionalism of pharmacy is also examined in light of the expanded scope of practice in which pharmacists increasingly find themselves practicing.
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Affiliation(s)
- Kelly Dowhower Karpa
- Department of Pharmacology, College of Medicine, Pennsylvania State University, Hershey, 17033-2360, USA.
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Contraception d’urgence. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S143-S152. [DOI: 10.1016/j.jogc.2016.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Peck R, Rella W, Tudela J, Aznar J, Mozzanega B. Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action. LINACRE QUARTERLY 2016; 83:35-51. [PMID: 27833181 PMCID: PMC5102184 DOI: 10.1179/2050854915y.0000000011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent studies have identified that levonorgestrel administered orally in emergency contraception (LNG-EC) is only efficacious when taken before ovulation. However, the drug does not consistently prevent follicular rupture or impair sperm function. OBJECTIVE The present systematic review is performed to analyze and more precisely define the extent to which pre-fertilization mechanisms of action may explain the drug's efficacy in pregnancy avoidance. We also examine the available evidence to determine if pre-ovulatory drug administration may be associated with post-fertilization effects. CONCLUSION The mechanism of action of LNG-EC is reviewed. The drug has no ability to alter sperm function at doses used in vivo and has limited ability to suppress ovulation. Our analysis estimates that the drug's ovulatory inhibition potential could prevent less than 15 percent of potential conceptions, thus making a pre-fertilization mechanism of action significantly less likely than previously thought. Luteal effects (such as decreased progesterone, altered glycodelin levels, and shortened luteal phase) present in the literature may suggest a pre-ovulatory induced post-fertilization drug effect. LAY SUMMARY Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA). The drug was originally thought to work by preventing fertilization. Recent research has cast doubt on this. Our review of the research suggests that it could act in a pre-fertilization capacity, and we estimate that it could prevent ovulation in only 15 percent or less of cases. The drug has no ability to alter sperm function and limited ability to suppress ovulation. Further, data suggest that when administered pre-ovulation, it may have a post-fertilization MOA.
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Affiliation(s)
- Rebecca Peck
- Florida State University, College of Medicine, Daytona Beach, Florida, USA
| | - Walter Rella
- Institut für Medizinische Anthropologie und Bioethik (IMABE), Wien, Austria
| | - Julio Tudela
- Observatory Bioethics of the Catholic University of Valencia, Spain
| | - Justo Aznar
- Life Sciences Institute of the Catholic University of Valencia, Spain
| | - Bruno Mozzanega
- Gynecology in the Department of Woman's and Child's Health, University of Padua, Obstetrics and Gynecology Unit, University of Padova, Italy
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Schneider AP, Kubat C, Zainer CM. Appreciation for Analysis of how Levonorgestrel Works and Reservations with the use of Meloxicam as Emergency Contraception. Linacre Q 2016; 83:52-68. [DOI: 10.1080/00243639.2016.1145894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
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Affiliation(s)
| | - Christopher Kubat
- Catholic Social Services of Southern Nebraska, Lincoln, Nebraska, USA
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21
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Abstract
Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception (). Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen-progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises (). The purpose of this Practice Bulletin is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase awareness of these methods among obstetrician-gynecologists and other gynecologic providers.
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Kelekci S, Aydogmus S. Emergency contraception: What is new? World J Obstet Gynecol 2015; 4:95-101. [DOI: 10.5317/wjog.v4.i4.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/19/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023] Open
Abstract
Unintended pregnancy rates remain high throughout the World and increase the risk of poor maternal and infant outcomes. Most of unintended pregnancies occur in women who were not using contraception or who became pregnant despite the reported use of contraception. Women who have had recent unprotected intercourse including those who have had another form of contraception fail are potential candidates for this intervention. Currently used emergency contraceptive methods are pills that contain combined estrogen-progesterone, only progestin, antiprogestins and copper intrauterine devices. The most common form of this type of contraception is oral progestin-only pills (levonorgestrel). The most effective method is copper intrauterine devices followed by anti-progestins and oral progestin-only pills. The major pathogenesis of oral emergency contraceptives is the prevention or delay of ovulation. Although conception is possible on only a few days of the cycle, emergency contraception is offered when indicated without regard to the timing of the menstrual cycle because of uncertainty in the timing of the ovulation. Levonorgestrel and E/P regimes are most effective as soon as possible after unprotected sexual intercourse. A linear relationship has been shown between effectiveness and the time of dose. The effectiveness continues for 120 h, but it is recommended to be used within 72 h after intercourse. Intrauterine devices may prevent pregnancy when 5 d after ovulation.
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Tittle V, Bull L, Boffito M, Nwokolo N. Pharmacokinetic and pharmacodynamic drug interactions between antiretrovirals and oral contraceptives. Clin Pharmacokinet 2015; 54:23-34. [PMID: 25331712 DOI: 10.1007/s40262-014-0204-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
More than 50 % of women living with HIV in low- and middle-income countries are of reproductive age, but there are limitations to the administration of oral contraception for HIV-infected women receiving antiretroviral therapy due to drug-drug interactions caused by metabolism via the cytochrome P450 isoenzymes and glucuronidation. However, with the development of newer antiretrovirals that use alternative metabolic pathways, options for contraception in HIV-positive women are increasing. This paper aims to review the literature on the pharmacokinetics and pharmacodynamics of oral hormonal contraceptives when given with antiretroviral agents, including those currently used in developed countries, older ones that might still be used in salvage regimens, or those used in resource-limited settings, as well as newer drugs. Nucleos(t)ide reverse transcriptase inhibitors (NRTIs), the usual backbone to most combined antiretroviral treatments (cARTs) are characterised by a low potential for drug-drug interactions with oral contraceptives. On the other hand non-NRTIs (NNRTIs) and protease inhibitors (PIs) may interact with oral contraceptives. Of the NNRTIs, efavirenz and nevirapine have been demonstrated to cause drug-drug interactions; however, etravirine and rilpivirine appear safe to use without dose adjustment. PIs boosted with ritonavir are not recommended to be used with oral contraceptives, with the exception of boosted atazanavir which should be used with doses of at least 35 µg of estrogen. Maraviroc, an entry inhibitor, is safe for co-administration with oral contraceptives, as are the integrase inhibitors (INIs) raltegravir and dolutegravir. However, the INI elvitegravir, which is given in combination with cobicistat, requires a dose of estrogen of at least 30 µg. Despite the growing evidence in this field, data are still lacking in terms of large cohort studies, randomised trials and correlations to real clinical outcomes, such as pregnancy rates, in women on antiretrovirals and hormonal contraception.
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Affiliation(s)
- Victoria Tittle
- Department of GUM/HIV Medicine, St. Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK,
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Overturf MD, Huggett DB. Responses to various exposure durations of levonorgestrel during early-life stages of fathead minnows (Pimephales promelas). AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2015; 161:33-40. [PMID: 25661708 DOI: 10.1016/j.aquatox.2015.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
Pharmaceuticals are routinely detected in the environment; and several of these compounds have been extensively researched due to their potential impacts to the endocrine system of aquatic organisms. The negative reproductive consequences of synthetic progestins in teleost species have only recently been investigated. The current study examined different exposure periods that may be most sensitive for levonorgestrel (LNG) in early-life stages of fathead minnow larvae. Larvae were exposed to a single concentration of LNG (125ng/L) for different durations from fertilized egg through 28 days post hatch (dph) with growth and mRNA expression of FSH, 3β-HSD, 20β-HSD, and CYP19a1 measured. Regardless of the duration of exposure, LNG significantly decreased growth in the fathead minnow larvae at day 28. For both 20β-HSD and CYP19a1, mRNA expression was decreased following LNG exposure durations ≥7 days. 3β-HSD and FSH showed similar trends after exposure to LNG with later stages of development exhibiting decreased expression. 20β-HSD and 3β-HSD were the only transcripts to remain down regulated once larvae were moved to clean water after the 7-14dph LNG exposure. This study is the first to investigate the effects of exposure time to a synthetic progestin on developing fish. Future research is needed to understand what impacts these changes have on adult stages of development.
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Affiliation(s)
- Matthew D Overturf
- Department of Biology, University of North Texas, Denton, TX 76203, USA.
| | - Duane B Huggett
- Department of Biology, University of North Texas, Denton, TX 76203, USA
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Abstract
There has been much debate regarding levonorgestrel emergency contraception's (LNG-EC's) method of action since 1999 when the Food and Drug Administration first approved its use. Proponents of LNG-EC have argued that they have moral certitude that LNG-EC works via a non-abortifacient mechanism of action, and claim that all the major scientific and medical data consistently support this hypothesis. However, newer medical data serve to undermine the consistency of the non-abortifacient hypothesis and instead support the hypothesis that preovulatory administration of LNG-EC has significant potential to work via abortion. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room protocols. In the future, technology such as the use of early pregnancy factor may have the potential to quantify how frequently preovulatory LNG-EC works via abortion. Lay Summary: How Plan B (levonorgestrel emergency contraception) works has been vigorously debated ever since the Food and Drug Administration approved it in 1999. Many doctors and researchers claim that it has either no-or at most-an extremely small chance of working via abortion. However, the latest scientific and medical evidence now demonstrates that levonorgestrel emergency contraception theoretically works via abortion quite often. The implications of the newer data have important ramifications for medical personnel, patients, and both Catholic and non-Catholic emergency room rape protocols.
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Affiliation(s)
| | - Rebecca Peck
- Florida State University College of Medicine, FL, USA
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Benchmark pregnancy rates and the assessment of post-coital contraceptives: an update. Contraception 2015; 91:344-9. [PMID: 25592079 DOI: 10.1016/j.contraception.2015.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/17/2014] [Accepted: 01/04/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In 2001, we provided benchmark estimates of probability of pregnancy given a single act of intercourse. Those calculations assumed that intercourse and ovulation are independent. Subsequent research has shown that this assumption is not valid. We provide here an update of previous benchmark estimates. STUDY DESIGN We reanalyze earlier data from two North Carolina studies that collected daily urine samples and recorded daily intercourse for multiple menstrual cycles. One study comprised 68 sexually active women with either an intrauterine device or tubal ligation. The second was of 221 women who planned to become pregnant and had discontinued use of any birth control at enrollment. Participants had no known fertility problems. New statistical analyses were based on Monte Carlo simulations and Bayesian methods. RESULTS The probability that a single act of intercourse occurs within a woman's fertile window is 25%, compared with 20% in previous calculations. The probability of pregnancy with intercourse on a given menstrual cycle day is correspondingly higher than previously estimated, with the largest increases occurring on menstrual days 12-22. These increases are, however, fairly small (for example, the peak chance of conception on menstrual day 13 increased from 8.6% to 9.7%). CONCLUSIONS Previous benchmark rates of pregnancy with one act of intercourse were moderately underestimated due to a mistaken assumption about the independence of intercourse and ovulation. IMPLICATIONS STATEMENT The chance of pregnancy with a single act of unprotected intercourse is greater than previously estimated. Previous benchmarks may underestimate the efficacy of post-coital contraception.
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Carvajal A, Sáinz M, Velasco V, García Ortega P, Treceño C, Martín Arias LH, Pellón M, García Sevillano L. Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting. Pharmacoepidemiol Drug Saf 2014; 24:93-7. [PMID: 25408302 DOI: 10.1002/pds.3725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/02/2014] [Accepted: 09/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The emergency contraceptive pill (ECP) containing levonorgestrel is dispensed without a prescription in Spain since 2009. An easy access could diminish unwanted pregnancies; however, there is a risk of misuse and, in any case, of developing some adverse events. The aim of the present study is to further learn the adverse effects of this ECP. METHODS An ad hoc follow-up study was carried out in three community pharmacies in a city of Central Spain; the sample was composed of those women asking for the ECP; they were interviewed by telephone after at least a month since the last menses. We completed the safety profile obtained with that coming from spontaneous reporting in Spain. RESULTS Out of 139 women surveyed, 113 developed any adverse event--two considered as severe; the most frequently reported events were menstrual disturbances, which accounted for 21% of all events. Through spontaneous reporting, 36 cases of whatever adverse events related to levonorgestrel as ECP were identified. Twenty-five cases were considered as severe. Both types of reaction and severity were significantly different in the follow-up study and in the spontaneous reporting. Some of the reactions identified, such as miscarriage, febrile neutropenia, and porphyria, are not included in the Summary of Product Characteristics. CONCLUSIONS Levonorgestrel as an ECP is mostly safe. Attention should be paid to some severe events and particularly to those risk factors for them to appear. Combining spontaneous reporting with an ad hoc follow-up study, the whole safety profile of a given medication can be obtained.
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Affiliation(s)
- Alfonso Carvajal
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Valladolid, Spain
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Zhang L, Ye W, Yu W, Cheng L, Shen L, Yang Z. Physical and mental development of children after levonorgestrel emergency contraception exposure: a follow-up prospective cohort study. Biol Reprod 2014; 91:27. [PMID: 24899575 DOI: 10.1095/biolreprod.113.117226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Levonorgestrel (LNG), a dedicated emergency contraception (EC) product, has been available over-the-counter in China for more than 14 yr. Although LNG-EC is considered to have no effects on the developing fetus if the contraceptive fails and pregnancy occurs, there have been a few studies specifically examining this issue. The purpose of this study was to compare the physical and mental development of children born after LNG-EC failure with that of a cohort of children born to mothers with no history of exposure to LNG or any teratogenic substances. A group of 195 children who were exposed to LNG-EC during their mothers' conception cycle (study group) were matched to a group of 214 children without exposure to LNG (control group). The physical and mental development of the children were evaluated and compared over a 2-yr period. There were four congenital malformations in the study group and three in the control group (2.1% vs. 1.4%, respectively, P > 0.05). Over the 2-yr follow-up period, there were no statistically significant differences between the two groups with respect to children's weight, height, head circumference, and intelligence scores, and the values of all parameters of both groups were similar to those of the national standards. In summary, LNG-EC has no effect on the physical growth, mental development, or occurrence of birth defects in children born from pregnancies in which EC failed.
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Affiliation(s)
- Lin Zhang
- Department of Obstetrics, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weiping Ye
- Department of Obstetrics, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Yu
- Department of Child Health Care, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Lixiao Shen
- Department of Child Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zujing Yang
- Department of Obstetrics, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Abstract
The Ethical and Religious Directives for Catholic Health Care Services allows the use of an emergency contraceptive for a woman who has been raped, as a defense against her attacker's sperm, provided the drug prevents fertilization and does not act against a conceived human life. Catholic emergency rooms around the country have been pressured to provide Plan B (LNG-EC) to patients seeking help after a sexual assault. Catholic bioethicists have supported the use of this drug based on their interpretation of the scientific literature regarding its mechanism of action. This paper presents a review of the mechanisms of action of LNG-EC when given during the fertile window, showing a high probability that it acts against human life rather than preventing fertilization, and proposes another class of drugs as a possible alternative.
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Shohel M, Rahman MM, Zaman A, Uddin MMN, Al-Amin MM, Reza HM. A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception. BMC Womens Health 2014; 14:54. [PMID: 24708837 PMCID: PMC3977662 DOI: 10.1186/1472-6874-14-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 03/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Unintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences. METHODS Randomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. RESULTS Every trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12-24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported. CONCLUSIONS The review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given, the more effective it seems to be.
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Affiliation(s)
- Mohammad Shohel
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Asif Zaman
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Md Mamun Al-Amin
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
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Overturf MD, Overturf CL, Carty DR, Hala D, Huggett DB. Levonorgestrel exposure to fathead minnows (Pimephales promelas) alters survival, growth, steroidogenic gene expression and hormone production. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2014; 148:152-161. [PMID: 24503577 DOI: 10.1016/j.aquatox.2014.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 06/03/2023]
Abstract
Human pharmaceuticals are commonly detected in the environment. Concern over these compounds in the environment center around the potential for pharmaceuticals to interfere with the endocrine system of aquatic organisms. The main focus of endocrine disruption research has centered on how estrogenic and androgenic compounds interact with the endocrine system to elicit reproductive effects. Other classes of compounds, such as progestins, have been overlooked. Recently, studies have investigated the potential for synthetic progestins to impair reproduction and growth in aquatic organisms. The present study utilizes the OECD 210 Early-life Stage (ELS) study to investigate the impacts levonorgestrel (LNG), a synthetic progestin, on fathead minnow (FHM) survival and growth. After 28 days post-hatch, survival of larval FHM was impacted at 462 ng/L, while growth was significantly reduced at 86.9 ng/L. Further analysis was conducted by measuring specific endocrine related mRNA transcript profiles in FHM larvae following the 28 day ELS exposure to LNG. Transcripts of 3β-HSD, 20β-HSD, CYP17, AR, ERα, and FSH were significantly down-regulated following 28d exposure to 16.3 ng/L LNG, while exposure to 86.9 ng/L significantly down-regulated 3β-HSD, 20β-HSD, CYP19A, and FSH. At 2,392 ng/L of LNG, a significant down-regulation occurred with CYP19A and ERβ transcripts, while mPRα and mPRβ profiles were significantly induced. No significant changes occurred in 11β-HSD, CYP11A, StAR, LHβ, and VTG mRNA expression following LNG exposure. An ex vivo steroidogenesis assay was conducted with sexually mature female FHM following a 7 day exposure 100 ng/L LNG with significant reductions observed in pregnenolone, 17α,20β-dihydroxy-4-pregnen-3-one (17,20-DHP), testosterone, and 11-ketotestosterone. Together these data suggest LNG can negatively impact FHM larval survival and growth, with significant alterations in endocrine related responses.
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Affiliation(s)
- Matthew D Overturf
- Department of Biology, University of North Texas, Denton, TX 76203, USA.
| | - Carmen L Overturf
- Department of Biology, University of North Texas, Denton, TX 76203, USA
| | - Dennis R Carty
- Department of Biology, University of North Texas, Denton, TX 76203, USA
| | - David Hala
- Department of Biology, University of North Texas, Denton, TX 76203, USA
| | - Duane B Huggett
- Department of Biology, University of North Texas, Denton, TX 76203, USA
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Affiliation(s)
- Bruno Mozzanega
- Department of Woman and Child Health, University of Padua, Padova, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padova, Italy
| | - Stefania Di Gangi
- Department of Woman and Child Health, University of Padua, Padova, Italy
| | - Erich Cosmi
- Department of Woman and Child Health, University of Padua, Padova, Italy
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Hermanny A, de Nascimento J, Fazano F, Munuce MJ, Bahamondes L. Effect of levonorgestrel as emergency contraception on spermatozoa function: a review. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Brache V, Cochon L, Deniaud M, Croxatto HB. Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens. Contraception 2013; 88:611-8. [PMID: 23809278 DOI: 10.1016/j.contraception.2013.05.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND The days just prior to ovulation are the most crucial for emergency contraception (EC) efficacy. Ulipristal acetate (UPA) and levonorgestrel's (LNG) capacity to inhibit follicular rupture have never been compared directly at this time of the cycle. STUDY DESIGN Raw data from three pharmacodynamics studies with similar methodology were pooled to allow direct comparison of UPA, LNG and LNG + meloxicam's ability to prevent ovulation when administered orally in the advanced follicular phase, with a leading follicle of ≥ 18 mm. RESULTS Forty eight LNG-treated (1.5 mg) cycles, 31 LNG (1.5 mg) + meloxicam (15 mg), 34 UPA (30 mg) cycles and 50 placebo cycles were compared. Follicle rupture was delayed for at least 5 days in 14.6%, 38.7%, 58.8% and 4% of the LNG-, LNG + meloxicam-, UPA- and placebo-treated cycles, respectively. UPA was more effective than LNG and placebo in inhibiting follicular rupture (p = .0001), while LNG, when administered at this time of the cycle, was not different than placebo. The addition of meloxicam improved the efficacy of LNG in preventing follicular rupture (p = .0292 vs. LNG; p = .0001 vs. placebo; non-significant vs. UPA). UPA was effective in preventing rupture in the 5 days following treatment, even when administered at the time of the luteinizing hormone (LH) surge (UPA 79%, LNG 14% and placebo 10%). None of the treatments were effective when administered on the day of the LH peak. The median time from treatment to rupture was 6 days during the ulipristal cycles and 2 days in the placebo and LNG/LNG + meloxicam cycles (p = .0015). CONCLUSION Although no EC treatment is 100% effective in inhibiting follicular rupture when administered in the late follicular phase, UPA is the most effective treatment, delaying ovulation for at least 5 days in 59% of the cycles. LNG is not different from placebo in inhibiting follicular rupture at this advanced phase of the cycle. No treatment was effective in postponing rupture when administered on the day of LH peak.
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36
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Gemzell-Danielsson K, Berger C, P.G.L. L. Emergency contraception — mechanisms of action. Contraception 2013; 87:300-8. [DOI: 10.1016/j.contraception.2012.08.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/20/2012] [Indexed: 12/30/2022]
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Abstract
There have been numerous attempts to control fertility after unprotected sexual intercourse (UPSI). From very bizarre methods like the vaginal application of Coca Cola to the more serious attempts using calcium antagonists influencing fertility parameters in sperm to hormonal methods or intrauterine devices. So far, hormonal methods preventing or delaying ovulation have proved to be the most popular starting with the combination of ethinyl estradiol and levonorgestrel (LNG), known as the Yuzpe regimen. The first dose had to be taken within 72 hours of UPSI, a second one 12 hours later. Later on, LNG alone, at first in a regimen similar to the Yuzpe method (2 × 0.75 mg 12 hours apart) showed to be more successful, eventually resulting in the development of a 1.5 mg LNG pill that combined good efficacy with a high ease of use. Several efficacious and easy to use methods for emergency contraception (EC) are available on the market today with the most widely spread being LNG in a single dose of 1.5 mg (given as one tablet of 1.5 mg or 2 tablets of 0.75 mg each) for administration up to 3 days (according to WHO up to 5 days) after UPSI. Its limitations are the non-optimal efficacy which is decreasing the later the drug is taken and the fact that it is only approved for up to 72 hours after UPSI. This regimen has no effect on the endometrium, corpus luteum function and implantation, is not abortive and don't harm the fetus if accidentally taken in early pregnancy. It has no impact on the rate of ectopic pregnancies. It has become the standard method used up to this day in most countries. Since the mid 1970s copper IUDs have been used for EC, which show a high efficacy. Their disadvantages lie in the fact that EC is considered an off label use for most IUDs (not for the GynFix copper IUD in the European Union) and that they might not be acceptable for every patient. Furthermore IUD-insertion is an invasive procedure and it is required trained providers and sterilized facilities. Mifepristone in the dosages of 10 or 25 mg is used with good results as an emergency contraceptive in China for up to 120 hours after UPSI, but has never received any significant consideration in Western countries. While high doses of mifepristone has an effect on endometrial receptivity and will inhibit ovulation if given in the follicular phase and prevent implantation if given in the early luteal phase, low doses such as 10 mg has no impact on the endometrium. Mifepristone does not increase the rate of ectopic pregnancies. The most recent development is the approval of the selective progesterone receptor modulator ulipristal acetate (UPA) in the dosage of 30 mg for EC up to 5 days after UPSI, combining the safe and easy application of the single dose LNG pill with an even higher efficacy. It has shown to be more efficacious than LNG and can be used for up to 120 hours after UPSI; the difference in efficacy is highest for 0-24 hours, followed by 0-72 hours following UPSI. No VTE has been reported following UPA-administration or any progesterone receptor modulator. No effect on endometrium, corpus luteum function and implantation has been observed with doses used for EC. Independent of the substance it should be noted that, if there is a choice, the intake of an oral emergency contraceptive pill should happen as soon as possible after the risk situation. A pre-existing pregnancy must be excluded. Possible contraindications and drug interactions must be considered according to the individual special product informations.
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Affiliation(s)
- Kristina Gemzell-Danielsson
- Department of Woman and Child Health, Karolinska Institutet, WHO-centre, Karolinska University Hospital, Stockholm, Sweden
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Rafie S, McIntosh J, Gardner DK, Gawronski KM, Karaoui LR, Koepf ER, Lehman KJ, McBane S, Patel-Shori NM. Over-the-Counter Access to Emergency Contraception without Age Restriction: An Opinion of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy. Pharmacotherapy 2013; 33:549-57. [DOI: 10.1002/phar.1229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sally Rafie
- University of California San Diego Health System; San Diego California
| | | | | | | | - Lamis R. Karaoui
- School of Pharmacy; Lebanese American University; Byblos Lebanon
| | - Erin R. Koepf
- University of New England College of Pharmacy; Portland Maine
| | | | - Sarah McBane
- Skaggs School of Pharmacy and Pharmaceutical Sciences; University of California San Diego; La Jolla California
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Koyama A, Hagopian L, Linden J. Emerging options for emergency contraception. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2013; 7:23-35. [PMID: 24453516 PMCID: PMC3888080 DOI: 10.4137/cmrh.s8145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.
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Affiliation(s)
- Atsuko Koyama
- Department of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura Hagopian
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
This review will focus on the available methods for emergency contraception (EC), efficacy, side effects and mechanisms of action. Copper intrauterine device (IUD) has been shown to be the most effective method for EC which can be continually used for regular contraception. However, this possibility is seldom used and may be little known. Among the hormonal EC methods 1.5 mg levonorgestrel is the most widely used EC pill while the more recently developed Ulipristal acetate (UPA) has been shown to be the most effective option. This is probably due to a more pronounced prevention of follicular rupture compared with other hormonal EC methods. Knowledge is needed to better advise lactating women and obese women on optimal EC method. Furthermore a possible interaction of UPA with regular hormonal contraception and possibilities for "bridging" from EC to regular contraception needs to be explored. To increase efficacy future studies should focus on EC methods that target the endometrium.
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Affiliation(s)
- P G L Lalitkumar
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/WHO-Collaborating Center, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Despite significant declines over the past 2 decades, the United States continues to have teen birth rates that are significantly higher than other industrialized nations. Use of emergency contraception can reduce the risk of pregnancy if used up to 120 hours after unprotected intercourse or contraceptive failure and is most effective if used in the first 24 hours. Indications for the use of emergency contraception include sexual assault, unprotected intercourse, condom breakage or slippage, and missed or late doses of hormonal contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring (ie, improper placement or loss/expulsion), and injectable contraception. Adolescents younger than 17 years must obtain a prescription from a physician to access emergency contraception in most states. In all states, both males and females 17 years or older can obtain emergency contraception without a prescription. Adolescents are more likely to use emergency contraception if it has been prescribed in advance of need. The aim of this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on safety, efficacy, and use of emergency contraception in teenagers; and (3) encourage routine counseling and advance emergency-contraception prescription as 1 part of a public health strategy to reduce teen pregnancy. This policy focuses on pharmacologic methods of emergency contraception used within 120 hours of unprotected or underprotected coitus for the prevention of unintended pregnancy. Emergency contraceptive medications include products labeled and dedicated for use as emergency contraception by the US Food and Drug Administration (levonorgestrel and ulipristal) and the "off-label" use of combination oral contraceptives.
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Munuce MJ, Zumoffen C, Cicaré J, Caille A, Ghersevich S, Bahamondes L. Effect of exposure to ulipristal acetate on sperm function. EUR J CONTRACEP REPR 2012; 17:428-37. [DOI: 10.3109/13625187.2012.725877] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Emergency contraception (EC) is any method used after sexual intercourse to prevent pregnancy. This article provides an overview of the history of EC methods and describes the current availability of oral and intrauterine EC. Oral forms include the Yuzpe regimen (combining ethinyl estradiol and levonorgestrel), levonorgestrel-only pills, and ulipristal acetate, which is a new emergency contraceptive drug recently approved by the US Food and Drug Administration. The copper T-380A intrauterine device can also be used for EC. Information about dosing, timing, access, and other considerations in the provision of EC is covered. Clinicians should be aware of all available options in order to counsel women in need of EC appropriately.
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Hartman LB, Monasterio E, Hwang LY. Adolescent contraception: review and guidance for pediatric clinicians. Curr Probl Pediatr Adolesc Health Care 2012; 42:221-63. [PMID: 22959636 DOI: 10.1016/j.cppeds.2012.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/11/2012] [Accepted: 05/23/2012] [Indexed: 01/19/2023]
Abstract
The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.
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Affiliation(s)
- Lauren B Hartman
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
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Nallasamy S, Kim J, Sitruk-Ware R, Bagchi M, Bagchi I. Ulipristal blocks ovulation by inhibiting progesterone receptor-dependent pathways intrinsic to the ovary. Reprod Sci 2012; 20:371-81. [PMID: 23012316 DOI: 10.1177/1933719112459239] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ulipristal acetate (UPA), a progesterone receptor (PR) modulator, is used as an emergency contraceptive in women. Here, using a mouse model, we investigated the mechanism of action of UPA as an ovulation blocker. In mice, ovulation is induced ~12 hours following the treatment with exogenous gonadotropins, including human chorionic gonadotropin (hCG), which mimics the action of luteinizing hormone (LH). When administered within 6 hours of hCG treatment, UPA is a potent blocker of ovulation. However, UPA's effectiveness declined significantly when it was given at 8 hours post hCG. Our study revealed that, when administered within 6 hours of hCG, UPA blocks ovulation by inhibiting PR-dependent pathways intrinsic to the ovary. At 8 hours post hCG, when the PR signaling has already occurred, UPA is unable to block ovulation efficiently. Collectively, these results indicated that UPA, when administered within a critical time window following the LH surge, blocks PR-dependent pathways in the ovary to function as an effective antiovulatory contraceptive.
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Abstract
OBJECTIVE To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. OPTIONS The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. OUTCOMES Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. EVIDENCE Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. VALUES The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). BENEFITS, HARMS, AND COSTS These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. SPONSOR The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C).
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Martinez AM, Thomas MA. Ulipristal acetate as an emergency contraceptive agent. Expert Opin Pharmacother 2012; 13:1937-42. [PMID: 22770536 DOI: 10.1517/14656566.2012.705832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Emergency contraceptive agents play a crucial role in preventing unplanned pregnancy. These agents and devices have been studied since the 1960s and have had varied results in terms of side effects and efficacy. A new oral tablet for emergency contraception (EC), ulipristal acetate (UPA) , is a selective progesterone receptor modulator and can be used up to 120 h following unprotected intercourse, without an increase in adverse effects or a decrease in efficacy. AREAS COVERED This article reviews studies that evaluate the pharmacodynamics, pharmacokinetics, clinical efficacy, and safety profile of UPA as an emergency contraceptive agent. EXPERT OPINION UPA, a selective progesterone receptor modulator, is administered as a single 30 mg dose for EC. This agent provides a comparable, if not better, efficacy and side effect profile than seen with levonorgestrel or mifepristone. Because it has both agonistic and antagonistic effects on the progesterone receptor, ongoing clinical trials are documenting UPA's use for patients with endometriosis and as an extended use contraceptive.
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Affiliation(s)
- Alan M Martinez
- University of Cincinnati, Center for Reproductive Health, Cincinnati, OH, USA
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48
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Hermanny A, Bahamondes MV, Fazano F, Marchi NM, Ortiz ME, Genghini MHRR, Croxatto HB, Bahamondes L. In vitro assessment of some sperm function following exposure to levonorgestrel in human fallopian tubes. Reprod Biol Endocrinol 2012; 10:8. [PMID: 22289514 PMCID: PMC3395846 DOI: 10.1186/1477-7827-10-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/30/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The mechanism of action of levonorgestrel (LNG) as emergency contraception (EC) remains a subject of debate and its effect on sperm function has been only partially explained. The aim of this study was to assess whether LNG at a similar dose to those found in serum following oral intake for EC could affect spermatozoa when exposed to human fallopian tubes in vitro. METHODS Fifteen mini-laparotomies were performed, the side on which ovulation occurred was recorded, and both tubes were removed and perfused with a suspension containing 1 × 10(6) motile spermatozoa, with or without LNG. Following 4-hour incubation, the tubes were sectioned to separate the isthmus and the ampulla. Each segment was flushed and the material was evaluated to quantify the number of motile sperm, the number of spermatozoa adhering to the oviductal epithelium and the acrosome reaction (AR) rate. RESULTS The addition of LNG did not significantly alter the number of recovered motile spermatozoa either at the isthmus or at the ampulla, nor did it have any effect on the number of recovered spermatozoa adhered to the human tubal epithelium. Furthermore, LNG did not affect the AR rate. No significant differences were found even when the side on which ovulation occurred was taken into account. CONCLUSIONS In a similar dose to that observed in serum following oral intake for EC, LNG had no effect on the number of motile spermatozoa recovered from the human fallopian tubes in vitro, on their adhesion to the tubal epithelium, distribution or AR rate. The possible effect of LNG as EC on sperm function remains poorly understood.
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Affiliation(s)
- Alexia Hermanny
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
| | - M Valeria Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
| | - Francisco Fazano
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
| | - Nadia M Marchi
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
| | | | - Maria Heloisa RR Genghini
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
| | - Horacio B Croxatto
- Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), 13084-971 Campinas, SP, Brazil
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Shrader SP, Hall LN, Ragucci KR, Rafie S. Updates in hormonal emergency contraception. Pharmacotherapy 2012; 31:887-95. [PMID: 21923590 DOI: 10.1592/phco.31.9.887] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In recent years, there have been many updates in hormonal emergency contraception. Levonorgestrel emergency contraception has been available for several years to prevent pregnancy when used within 72 hours after unprotected intercourse or contraceptive failure, and it was recently approved for nonprescription status for patients aged 17 years or older. Current research suggests that the primary mechanism of action is delaying ovulation. Ulipristal is the newest emergency contraception, available by prescription only, approved for use up to 120 hours after unprotected intercourse or contraceptive failure. The primary mechanism of action is delaying ovulation. When compared with levonorgestrel emergency contraception, ulipristal was proven noninferior in preventing pregnancy. Evidence suggests that ulipristal does not lose efficacy from 72-120 hours; however, more studies are warranted to support this claim. Many misconceptions and controversies about hormonal emergency contraception still exist. Research does not support that increased access to emergency contraception increases sexual risk-taking behavior. Several studies suggest that health care providers, including pharmacists, could benefit from increased education about emergency contraception. It is important for pharmacists to remain up-to-date on the most recent hormonal emergency contraception products and information, as pharmacists remain a major point of access to emergency contraception.
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Affiliation(s)
- Sarah P Shrader
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, South Carolina 29425, USA.
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Krikun G, Booth CJ, Buchwalder L, Schatz F, Osol G, Mandala M, Lockwood CJ. Effects of etonogestrel treatment in the reproductive organs and uterine arteries of nonoophorectomized guinea pigs. Reprod Sci 2012; 19:400-6. [PMID: 22267537 DOI: 10.1177/1933719111424452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The endometria of women treated with long-term progestin-only contraceptives (LTPOCs) display abnormally enlarged, fragile blood vessels, decreased endometrial blood flow, oxidative stress, and unpredictable focal abnormal endometrial bleeding. Because human studies on the effects of LTPOC treatment are constrained for ethical and practical reasons, we assessed the suitability of nonoophorectomized guinea pigs (GPs) to best mimic the hormonal milieu of women. The present study demonstrates that treatment of GPs parallels the morphological changes following LTPOC treatment of the human endometrium and ovaries. Specifically, treatment resulted in larger hyperemic, uteri compared with controls. Histopathologic and immunohistochemical analysis demonstrated fewer endometrial glands, decreased luminal mucus, increased numbers of blood vessels, and focal hemorrhage. While increased staining for the cell mitosis marker, Ki67, was present in the zona functionalis, no such increase occurred in the basalis. Lastly, effects on vasomotor features of uterine arteries suggest changes that favor increased resistance and reduced blood flow promoting decreased ability to withstand elevations in transmural pressure.
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Affiliation(s)
- Graciela Krikun
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, CT 06520, USA.
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